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Background Obesity is an established cardiovascular risk factor in patients with hypertrophic cardiomyopathy. Postoperative atrial fibrillation (POAF) is one of the most common complications after surgery in patients with obstructive hypertrophic cardiomyopathy (OHCM). We aimed to determine the impact of body mass index (BMI) on the occurrence of POAF in patients with OHCM who underwent septal myectomy. Methods and Results In all, 712 OHCM patients without previous atrial fibrillation who underwent septal myectomy were identified. Patients were stratified into 3 groups based on BMI. Of these, 224 (31.5%) had normal weight (BMI

BackgroundAtrial fibrillation (AF) often occurs after cardiac surgery and is associated with increased risk of stroke and mortality. Prior studies support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an increased production of inflammatory mediators from EAT.MethodsThe study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.ResultsForty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p =

The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.

Competing Interests: Declaration of competing interest The authors have no competing interest to declare.

Aims Systemic inflammation and increased activity of atrial NOX2-containing NADPH oxidases have been associated with the new onset of atrial fibrillation (AF) after cardiac surgery. In addition to lowering LDL-cholesterol, statins exert rapid anti-inflammatory and antioxidant effects, the clinical significance of which remains controversial. Methods and results We first assessed the impact of cardiac surgery and cardiopulmonary bypass (CPB) on atrial nitroso-redox balance by measuring NO synthase (NOS) and GTP cyclohydrolase-1 (GCH-1) activity, biopterin content, and superoxide production in paired samples of the right atrial appendage obtained before (PRE) and after CPB and reperfusion (POST) in 116 patients. The effect of perioperative treatment with atorvastatin (80 mg once daily) on these parameters, blood biomarkers, and the post-operative atrial effective refractory period (AERP) was then evaluated in a randomized, double-blind, placebo-controlled study in 80 patients undergoing cardiac surgery on CPB. CPB and reperfusion led to a significant increase in atrial superoxide production (74% CI 71–76%, n  = 46 paired samples, P  < 0.0001) and a reduction in atrial tetrahydrobiopterin (BH4) (34% CI 33–35%, n  = 36 paired samples, P  < 0.01), and in GCH-1 (56% CI 55–58%, n  = 26 paired samples, P  < 0.001) and NOS activity (58% CI 52–67%, n  = 20 paired samples, P  < 0.001). Perioperative atorvastatin treatment prevented the effect of CPB and reperfusion on all parameters but had no significant effect on the postoperative right AERP, troponin release, or NT-proBNP after cardiac surgery. Conclusion Perioperative statin therapy prevents post-reperfusion atrial nitroso-redox imbalance in patients undergoing on-pump cardiac surgery but has no significant impact on postoperative atrial refractoriness, perioperative myocardial injury, or markers of postoperative LV function. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01780740 [ABSTRACT FROM AUTHOR]

Objective: Minimal invasive extracorporeal circuits (MiECC) have been associated with a significant reduction in the incidence of postoperative atrial fibrillation (AF). Nevertheless, AF remains one of the most common complications following elective primary coronary artery bypass grafting (CABG). The aim of this study was to identify the predictors of AF persisting beyond the hospital stay in elective primary CABG patients. Methods: We conducted a retrospective analysis for the predictors of AF that persisted beyond discharge between all patients who received an elective isolated CABG in our institution between 2009 and 2014. Patients with a positive history for intermittent or persistent AF were excluded from the analysis. Almost all patients were discharged to a rehabilitation facility where they stayed for 3 to 4 weeks postoperatively. At rehab approximately 91% of them received Holter monitoring at least once prior to their discharge. Results: A total of 770 patients were included in the analysis of which 763 patients survived the in-hospital stay. The incidence of AF at hospital discharge was 4.2% (32/763) while that on Holter monitor at Rehab was 1.5% (10/685). Age and the type of extracorporeal circuit (ECC) utilized were the only significant predictors for both AF at discharge (p < 0.01 both) and on Holter monitor in rehab (p < 0.01 and 0.02, respectively). This was also confirmed on multivariate analysis. Conclusion: Our findings show that the benefits of MiECC regarding the incidence of postoperative AF persist beyond hospital discharge. They may thus positively influence the outcomes of patients beyond the early postoperative period. [ABSTRACT FROM AUTHOR]

Pre-existing Ca2+ handling abnormalities constitute the arrhythmogenic substrate in patients developing postoperative atrial fibrillation (POAF), a common complication after cardiac surgery. Postoperative interleukin (IL)-6 levels are associated with atrial fibrosis in several animal models of POAF, contributing to atrial arrhythmias. Here, we hypothesize that IL-6-mediated-Ca2+ handling abnormalities contribute to atrial fibrillation (AF) in sterile pericarditis (SP) rats, an animal model of POAF. SP was induced in rats by dusting atria with sterile talcum powder. Anti-rat-IL-6 antibody (16.7 μg/kg) was administered intraperitoneally at 30 min after the recovery of anesthesia. In vivo electrophysiology, ex vivo optical mapping, western blots, and immunohistochemistry were performed to elucidate mechanisms of AF susceptibility. IL-6 neutralization ameliorated atrial inflammation and fibrosis, as well as AF susceptibility in vivo and the frequency of atrial ectopy and AF with a reentrant pattern in SP rats ex vivo. IL-6 neutralization reversed the prolongation and regional heterogeneity of Ca2+ transient duration, relieved alternans, reduced the incidence of discordant alternans, and prevented the reduction and regional heterogeneity of the recovery ratio of Ca2+ transient. In agreement, western blots showed that IL-6 neutralization reversed the reduction in the expression of ryanodine receptor 2 (RyR2) and phosphorylated phospholamban. Acute IL-6 administration to isolated rat hearts recapitulated partial Ca2+ handling phenotype in SP rats. In addition, intraperitoneal IL-6 administration to rats increased AF susceptibility, independent of fibrosis. Our results reveal that IL-6-mediated-Ca2+ handling abnormalities in SP rats, especially RyR2-dysfunction, independent of IL-6-induced-fibrosis, early contribute to the development of POAF by increasing propensity for arrhythmogenic alternans. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery; however, antiarrhythmic strategies have not lowered the rate of POAF. This study aimed to identify specific gene transcripts of atrial inflammation, inflammatory handling, and oxidative stress associated with POAF. Left atrial tissue was obtained from 50 patients undergoing intended degenerative mitral repair who did not have any of the following risk factors for POAF: history of atrial fibrillation or other arrhythmia, left atrial diameter greater than 6.0 cm, or left ventricular ejection fraction less than 40%. Postoperative outcomes and left atrial tissue messenger ribonucleuc acid (mRNA) levels were recorded. Parametric 2-sample t-tests and chi-square tests were used to evaluate for statistical significance in comparing POAF and non-POAF groups. Within 30 days of surgery, 19 of 50 of patients (38%) developed POAF. There were no significant preoperative, intraoperative, or postoperative differences between POAF and non-POAF patients. In the tissue transcriptome analysis, POAF patients were found to have a worse preoperative inflammatory state with higher levels of tumor necrosis factor alpha, Interleukin-6, and nuclear factor of kappa light polypeptide gene enhancer in B-cells mRNA, worse inflammatory handling capacity with lower levels of nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor mRNA, and reduced antioxidant defenses with lower levels of glutathione synthetase, glutathione reductase, and mitochondrial superoxide dismutase 2 mRNA. This study found POAF patients to have preoperative left atrial tissue profiles suggestive of more inflammation, worse inflammatory handling, and reduced antioxidant defenses against oxidative stress. Investigation of therapies targeted to the tissue-specific inflammatory transcriptome of POAF patients is warranted. [ABSTRACT FROM AUTHOR]

Aims: Amiodarone reduces the incidence of atrial fibrillation (AF) following coronary artery bypass surgery; however, the benefit of perioperative amiodarone in patients undergoing septal myectomy (SM) for obstructive hypertrophic cardiomyopathy (oHCM) has not been studied. We hypothesized that prophylactic amiodarone would reduce the incidence of postoperative AF (POAF) following SM for oHCM. Methods and Results: A single‐centre, pre‐post intervention open‐label study of oral amiodarone (200 mg twice daily starting 7 days preoperatively and 200 mg once daily continuing for 30 days postoperatively) in patients without prior AF undergoing SM for oHCM from 2014 to 2018. The primary outcome was incident AF within 30 days. Secondary outcomes were unplanned readmission, AF treatment, total and intensive care unit (ICU) length of stay (LOS), and pacemaker implantation for high‐grade atrioventricular (AV) block. 61 patients met inclusion criteria with 34 (55.8%) in the pre‐intervention (control) group and 27 (44.2%) in the post‐intervention (amiodarone) group. The incidence of POAF was 11.0% in the amiodarone group compared with 38.2% in the control group (P = 0.017). After adjusting for age, amiodarone was associated with less POAF [adjusted odds ratio (aOR) 0.21; 95% confidence interval (CI) 0.05, 0.76; P = 0.016]. ICU (2 days [IQR 1, 4] vs. 3 days [IQR 2, 4]; P = 0.165) and total (6 days [IQR 5, 6] vs. 6 days [IQR 5, 7]; P = 0.165) LOS were similar, as was the rate of pacemaker implantation (7.4% vs. 8.3%, P > 0.999). There were no adverse events associated with amiodarone. Conclusions: Perioperative oral amiodarone is safe and was associated with lower incidence of POAF following SM for oHCM. [ABSTRACT FROM AUTHOR]

Background: postoperative atrial fibrillation (POAF) is a common cardiac surgery complication that is associated with increased complications and negative outcomes, but the association between presurgical atrial conduction abnormalities and POAF has not been investigated clinically during premature atrial S1S2 stimulation. This clinical study sought to examine whether intraoperative premature atrial stimulation reveals increased areas of slowed and/or blocked conduction in patients that develop POAF.Methods: High-density intraoperative epicardial left atrial mapping was conducted in 20 cardiac surgery patients with no prior history of atrial fibrillation (AF). In 20 patients, 6 (30%) developed POAF. A flexible-array of 240-electrodes was placed on the posterior left atrial wall in between the pulmonary veins. Activation maps were generated for sinus and premature atrial S1S2 stimulated beats. The area of conduction block (CB), conduction delay (CD) and the combination of both (CDCB) for conduction velocity < 0.1, 0.1 ≤ x < 0.2 and < 0.2 m/s, respectively were quantified.Results: For a premature atrial S2 beat with shortest cycle length captured, conduction velocity maps revealed a significantly higher area for CD (13.19 ± 6.59 versus 6.06 ± 4.22 mm2, p = 0.028) and CDCB (17.36 ± 8.75 versus 7.41 ± 6.39 mm2, p = 0.034), and a trend toward a larger area for CB (4.17 ± 3.66 versus 1.34 ± 2.86 mm2, p = 0.063) in patients who developed POAF in comparison to those that remained in the sinus. Sinus and S1 paced beats did not show substantial differences in abnormal conduction areas between patients with and without POAF.Conclusion: In comparison to sinus and S1 beats, premature atrial S2 beats accentuate conduction abnormalities in the posterior left atrial wall of cardiac surgery patients that developed POAF. [ABSTRACT FROM AUTHOR]

Objectives: l-Carnitine, a quaternary amine, improves fatty acid metabolism in the heart and has anti-inflammatory effects. Several studies have reported the efficacy of l-carnitine for the prophylaxis of arrhythmia. We assessed the clinical effectiveness of l-carnitine in preventing postoperative atrial fibrillation (POAF) in aortic valve surgery. Methods: Thirty patients who underwent aortic valve surgery were included. Fifteen patients had no prophylaxis other than conventional measures (control), while 15 patients received oral l-carnitine for 9 days (daily dose of 3 g). The incidence of POAF during 1 week after surgery was compared between the two groups. The multivariable logistic regression analysis for POAF was performed using the pre- and intraoperative parameters. Results: Preoperative characteristics and operative data were comparable between the groups. The POAF rate was significantly lower in the l-carnitine group than in the control (20% and 60%, respectively; P = 0.025). l-Carnitine use was an independently negative predictor for POAF (odds ratio 0.067; 95% confidence interval 0.006–0.768). Conclusions: l-Carnitine administration may have potential for the prevention of POAF in aortic valve surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. Methods This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. Results Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2,p = 0.006). Conclusions These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

Abstract Background Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy, which may extend the inpatient hospital stay. Minimally invasive esophagectomy (MIE) has been increasingly used in clinical practice; however, its POAF risk and short-term mortality remain unclear. This study aimed to examine the POAF risk and in-hospital mortality rate between patients receiving MIE and open esophagectomy (OE). Methods Esophageal cancer patients who underwent MIE or OE from a retrospective cohort study were evaluated. A multivariate logistic regression model was built to assess the associations between esophagectomy (MIE vs. OE) and various outcomes (POAF, in-hospital mortality). Covariates included age, sex, body mass index, neoadjuvant therapy, tumor stage, surgery incision type, comorbidities, cardia conditions, peri-operative medication, and complications. Results Of the 484 patients with esophageal cancer, 63 received MIE. A total of 53 patients developed POAF. Compared to patients receiving OE, MIE patients had 81% reduced odds of POAF (adjusted odds ratio [aOR] 0.185, 95% CI 0.039–0.887, P = 0.035). No statistically significant association was found for in-hospital mortality (aOR 0.709, 95% CI 0.114–4.409, P = 0.712). Conclusions MIE is associated with a lower risk of POAF, compared to traditional surgery. No significant short-term survival benefit was found for MIE.

Christoffer Valdorff Madsen,1,2 Lars Nannestad Jørgensen,3 Bonna Leerhøy,3 Ismail Gögenur,4 Sarah Ekeloef,4 Ahmad Sajadieh,1 Helena Domínguez1,2 1Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark; 2Department of Biomedical Science, Copenhagen University, Copenhagen, Denmark; 3Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark; 4Department of Surgery, Zealand University Hospital, Køge, DenmarkCorrespondence: Helena DomínguezDepartment of Cardiology, Bispebjerg-Frederiksberg Hospital, Nordre Fasanvej 57, Frederiksberg 2000, DenmarkTel +45 38166068Fax +45 22989343Email mdom0002@regionh.dkAbstract: Postoperative atrial fibrillation (POAF) in relation to abdominal surgery can cause clinical deterioration, prolonged hospitalization, admittance to intensive care units, stroke and increased mortality. The current review focus on patients developing POAF in relation to abdominal surgery and aims to present the current knowledge on predictors of this condition. Furthermore, predictors identified in other surgical populations that may be transferable and guide future research within the field of abdominal surgery will be presented. A systematic literature search of patients undergoing abdominal surgery and developing POAF was performed on PubMed and Embase. All types of study interventions, comparators and designs were included. All studies included reported POAF as primary or secondary outcome. All peer-reviewed English full-text manuscripts regardless of publication date were included. We included five studies out of the 149 unique records identified. Age, congestive heart failure, hypertension, vascular disease and surgical approach are risk factors associated with the development of POAF. Furthermore, inflammation biomarkers, dobutamine stress echocardiography and cardiac single-photon emission computed tomography can predict POAF. Insights from other surgical cohorts reveal that other biomarkers (ie, brain natriuretic peptide (BNP) and N-terminal pro-BNP), electrocardiography and echocardiography can be used to predict POAF and may be applied in future research projects within the field of abdominal surgery. In conclusion, very scarce evidence is currently available in predicting POAF after abdominal surgery. However, predicting POAF seems possible and feasible, why the authors encourage readers to initiate new research to close the current knowledge gap and improve clinical management.Keywords: postoperative atrial fibrillation, surgery, biomarkers, electrocardiogram, echocardiography, complications

Abstract Introduction Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery associated with important morbidity, mortality, and costs. To assess the effectiveness of preventive interventions, an important prerequisite is to have access to accurate measures of POAF incidence. The aim of this study was to develop and validate such a measure. Methods A validation study was conducted at two large Canadian university health centers. First, a random sample of 976 (10.4%) patients who had cardiac surgery at these sites between 2010 and 2016 was generated. Then, a reference standard assessment of their medical records was performed to determine their true POAF status on discharge (positive/negative). The accuracy of various algorithms combining diagnostic and procedure codes from: 1) the current hospitalization, and 2) hospitalizations up to 6 years before the current hospitalization was assessed in comparison with the reference standard. Overall and site-specific estimates of sensitivity, specificity, positive (PPV), and negative (NPV) predictive values were generated, along with their 95%CIs. Results Upon manual review, 324 (33.2%) patients were POAF-positive. Our best-performing algorithm combining data from both sites used a look-back window of 6 years to exclude patients previously known for AF. This algorithm achieved 70.4% sensitivity (95%CI: 65.1–75.3), 86.0% specificity (95%CI: 83.1–88.6), 71.5% PPV (95%CI: 66.2–76.4), and 85.4% NPV (95%CI: 82.5–88.0). However, significant site-specific differences in sensitivity and NPV were observed. Conclusion An algorithm based on administrative data can identify POAF patients with moderate accuracy. However, site-specific variations in coding practices have significant impact on accuracy.

Introduction: Off-pump coronary artery bypass (OPCAB) surgery is associated with evasion of complications of cardiac bypass. The incidence of postoperative atrial fibrillation (POAF) may also be reduced because of less ischemia and inflammation. Aim: Prospective evaluation of utility of CHA2DS2-VASc score in the prediction of POAF after OPCAB surgery. Methodology: In this prospective, observational study, 99 patients who underwent elective isolated OPCAB surgery were included. Patients with pacemaker in situ, receiving antiarrhythmic drugs preoperatively, and preexisting atrial fibrillation were excluded. A detailed history taking and physical examination were done preoperatively and the CHA2DS2-VASc scores were calculated for each patient. They received a standard anesthetic including midazolam, fentanyl, propofol, vecuronium, and isoflurane. The number of grafts, inotrope usage, and blood product transfusion in the perioperative period were noted. Patients were followed up for 5 days after surgery for development of new onset POAF requiring treatment. Results: About 20 of the 99 patients developed POAF. POAF occurred most commonly on postoperative day 2. They were older, more likely diabetic, had preoperative diastolic dysfunction, and received blood products perioperatively. POAF group had higher mean CHA2DS2-VASc score (3.6 ± 0.821 vs. 2.11 ± 1.35) and had longer hospital stay (16.85 ± 8.61 vs. 12.6 ± 4.05 days) than no POAF group. The cutoff for CHA2DS2-VASc score was 3, which showed 90% sensitivity, 77.22% specificity, 50% positive predictive value, and 96.63% negative predictive value. Conclusions: CHA2DS2-VASc score is useful in predicting POAF after OPCAB surgery. Higher the CHA2DS2-VASc score, greater is the possibility of development of POAF.

Abstract Background Postoperative atrial fibrillation occurs in up to 30% of patients after coronary artery bypass graft (CABG) and its cause is unknown. The aim of the study was to evaluate whether concentration of resistin in surrounding coronary artery perivascular adipose tissue (PVAT) is related to postoperative atrial fibrillation occurrence. Methods A total number of 46 patients (35 male, 11 female; median age 66.5) were qualified for elective CABG. Medical history, laboratory test results and echocardiographic parameters were noted. Patients were monitored up to 3 days after CABG and then were divided into groups with and without postoperative atrial fibrillation occurrence. Fragments of PVAT were collected intra-operatively: near the left anterior descending artery and main left coronary artery. The concentration of resistin was determined by Human Resistin Quantikine ELISA Kit and expressed as ng/g. A multivariate stepwise logistic regression analysis was performed to find variables related to postoperative atrial fibrillation occurrence. Results Postoperative atrial fibrillation occurred in 14 (30.4%) patients. The patients with and without postoperative atrial fibrillation were similar in age, gender, epicardial adipose tissue thickness and laboratory parameters. The concentration of resistin in PVAT near the left main coronary artery was significantly higher in patients with postoperative atrial fibrillation than in those without the complication (P = 0.03). In the multivariate stepwise logistic regression analysis the concentration of resistin above cut-off point 54 ng/g in PVAT near left main coronary artery was independently related to postoperative atrial fibrillation occurrence (OR: 7.7; 95% CI:1.4–42.2 p = 0.02). Conclusions The higher concentrations of resistin in PVAT near the left main coronary artery which is located close to the left atrium are associated with postoperative atrial fibrillation.

Abstract Background Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. Methods Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. Results Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p

Pre-existing Ca2+ handling abnormalities constitute the arrhythmogenic substrate in patients developing postoperative atrial fibrillation (POAF), a common complication after cardiac surgery. Postoperative interleukin (IL)-6 levels are associated with atrial fibrosis in several animal models of POAF, contributing to atrial arrhythmias. Here, we hypothesize that IL-6-mediated-Ca2+ handling abnormalities contribute to atrial fibrillation (AF) in sterile pericarditis (SP) rats, an animal model of POAF. SP was induced in rats by dusting atria with sterile talcum powder. Anti-rat-IL-6 antibody (16.7 μg/kg) was administered intraperitoneally at 30 min after the recovery of anesthesia. In vivo electrophysiology, ex vivo optical mapping, western blots, and immunohistochemistry were performed to elucidate mechanisms of AF susceptibility. IL-6 neutralization ameliorated atrial inflammation and fibrosis, as well as AF susceptibility in vivo and the frequency of atrial ectopy and AF with a reentrant pattern in SP rats ex vivo. IL-6 neutralization reversed the prolongation and regional heterogeneity of Ca2+ transient duration, relieved alternans, reduced the incidence of discordant alternans, and prevented the reduction and regional heterogeneity of the recovery ratio of Ca2+ transient. In agreement, western blots showed that IL-6 neutralization reversed the reduction in the expression of ryanodine receptor 2 (RyR2) and phosphorylated phospholamban. Acute IL-6 administration to isolated rat hearts recapitulated partial Ca2+ handling phenotype in SP rats. In addition, intraperitoneal IL-6 administration to rats increased AF susceptibility, independent of fibrosis. Our results reveal that IL-6-mediated-Ca2+ handling abnormalities in SP rats, especially RyR2-dysfunction, independent of IL-6-induced-fibrosis, early contribute to the development of POAF by increasing propensity for arrhythmogenic alternans.

Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, which often occurs within 30 postoperative days, especially peaking at 2-3 days. Antiarrhythmic medications such as amiodarone are recommended in clinical practice for the prophylaxis and treatment of POAF. However, conventional oral administration is hindered due to delayed drug action and high risks of systemic toxicity, and emerging localized delivery strategies suffer from a limited release duration (less than 30 days). Herein, we develop a microneedle (MN) patch for localized delivery of amiodarone to the atria in a "First Rapid and Then Sustained" dual-release mode. Specifically, this patch is composed of a needle array integrated with an amiodarone-loaded reservoir for a sustained and steady release for over 30 days; and an amiodarone-containing coating film deposited on the needle surface via the Langmuir-Blodgett technique for a rapid release at the first day. Upon this design, only one MN patch enables a higher drug accumulation in the atrial tissue at the first day than oral administration and simultaneously remains therapeutical levels for over 30 days, despite at a significantly reduced drug dosage (5.08 mg in total versus ∼10 mg per day), thereby achieving ideal preventive effects and safety in a rat model. Our findings indicate that this MN device provides a robust and efficient delivery platform for long-term prophylaxis of POAF.

Background: The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new-onset postoperative atrial fibrillation (POAF), and compare with patients newly diagnosed with non-POAF., Methods and Results: This retrospective cohort study identified patients newly diagnosed with atrial fibrillation or flutter between 2012 and 2021 using administrative claims data from OptumLabs Data Warehouse. The POAF cohort included 118 366 patients newly diagnosed with atrial fibrillation or flutter within 30 days after surgery. The non-POAF cohort included the remaining 315 832 patients who were newly diagnosed with atrial fibrillation or flutter but not within 30 days after a surgery. OAC initiation increased from 28.9% to 44.0% from 2012 to 2021 in POAF, and 37.8% to 59.9% in non-POAF; 12-month medication adherence increased from 47.0% to 61.8% in POAF, and 59.7% to 70.4% in non-POAF. The median time to OAC discontinuation was 177 days for POAF, and 242 days for non-POAF. Patients who saw a cardiologist within 90 days of the first atrial fibrillation or flutter diagnosis, regardless of POAF or non-POAF, were more likely to initiate OAC (odds ratio, 2.92 [95% CI, 2.87-2.98]; P <0.0001), adhere to OAC (odds ratio, 1.08 [95% CI, 1.04-1.13]; P <0.0001), and less likely to discontinue (odds ratio, 0.83 [95% CI, 0.82-0.85]; P <0.0001) than patients who saw a surgeon or other specialties., Conclusions: The use of and adherence to OAC were higher in non-POAF patients than in POAF patients, but they increased over time in both groups. Patients managed by cardiologists were more likely to use and adhere to OAC, regardless of POAF or non-POAF.

Background: Serum bone morphogenetic protein 10 (BMP10) blood levels are a marker for history of atrial fibrillation (AF) and for major adverse cardiovascular events in patients with AF, including stroke, AF recurrences after catheter ablations, and mortality. The predictive value of BMP10 in patients undergoing cardiac surgery and association with morphologic properties of atrial tissues are unknown., Objectives: This study sought to study the correlation between BMP10 levels and preoperative clinical traits, occurrence of early and late postoperative atrial fibrillation (POAF), and atrial fibrosis in patients undergoing cardiac surgery., Methods: Patients with and without preoperative AF history undergoing first cardiac surgery were included (RACE V, n = 147). Preoperative blood biomarkers were analyzed, left (n = 114) and right (n = 125) atrial appendage biopsy specimens were histologically investigated after WGA staining, and postoperative rhythm was monitored continuously with implantable loop recorders (n = 133, 2.5 years)., Results: Adjusted multinomial logistic regression indicated that BMP10 accurately reflected a history of persistent AF (OR: 1.24, 95% CI: 1.10-1.40, P = 0.001), similar to NT-pro-BNP. BMP10 levels were associated with increased late POAF 90 occurrence after adjustment for age, sex, AF history, and early POAF occurrence (HR: 1.07 [per 0.1 ng/mL increase], 95% CI: 1.00-1.14, P = 0.041). Left atrial endomysial fibrosis (standardized β = 0.22, P = 0.041) but not overall fibrosis (standardized Β = 0.12, P = 0.261) correlated with circulating BMP10 after adjustment for age, sex, AF history, reduced LVF, and valvular surgery indication., Conclusions: Increased BMP10 levels were associated with persistent AF history, increased late POAF incidence, and LAA endomysial fibrosis in a diverse sample of patients undergoing cardiac surgery., Competing Interests: Funding Support and Author Disclosures Supported by Netherlands Heart Foundation (CVON2014-09, RACE V Reappraisal of Atrial Fibrillation: Interaction between hyper Coagulability, Electrical remodeling, and Vascular Destabilization in the Progression of AF); European Union’s Horizon 2020 research and innovation programmed under grant agreement No 965286. Dr Schotten has received consultancy fees or honoraria from Universitas' della Svizzera Italiana, Roche Diagnostics, EP Solutions Inc, Johnson & Johnson Medical Limited, and Bayer Healthcare, and is a cofounder and shareholder of Your Rhythmics BV, a spinoff company of the Maastricht University. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery and is associated with adverse clinical outcomes. Our study aimed at determining the clinical and echocardiographic predictors of POAF in patients with cardiac surgery and management of this group of patients may improve their outcome., Methods: We prospectively enrolled patients from the department of cardiovascular surgery in the Second Hospital of Tianjin Medical University from October 23, 2020 to October 30, 2022, without a history of atrial fibrillation. Cox regression was used to identify significant predictors of POAF., Results: A total of 217 patients (79 [36.41 %] were female, 63.96 ± 12.32 years) were included. 88 (40.55 %) patients met the criteria for POAF. Cox regression showed that preoperative left atrial diameter (LAD) (HR: 1.040, 95 % CI 1.008-1.073, p = 0.013) and postoperative QRS/LVEDD (HR: 0.398, 95 % CI 0.193-0.824, p = 0.013) and E/e' (HR: 1.029, 95 % CI 1.002-1.057，p = 0.033) were predictors of POAF., Conclusion: Preoperative LAD and postoperative QRS/LVEDD and E/e' were predictors of POAF in patients undergoing cardiac surgery., Trial Registration Site: http://www.chictr.org.cn., Registration Number: ChiCTR2200063344., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Postoperative atrial fibrillation (POAF) is commonly seen in patients who underwent coronary artery bypass grafting (CABG), increasing the risk of morbidity, mortality, and hospital expenses. This study aimed to evaluate the effect of partial cardiac denervation, which is achieved by cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove, on the prevention of POAF after CABG. Patients planned for CABG at our center were screened for eligibility in this study. A total of 430 patients were randomized into the intervention (partial cardiac denervation) group and control group. Intraoperative high-frequency electrical stimulation and further histologic analysis were performed in a certain number of patients to confirm the existence of ganglia. All patients were continuously monitored for the incidence of POAF through an electrophysiologic device until the sixth day postoperatively, and required to complete a 30-day follow-up (12-lead electrocardiogram and echocardiogram assessment) after discharge. The primary end point is the incidence of POAF, whereas the secondary end points are the cost-effectiveness and safety outcomes. In conclusion, this trial will evaluate whether partial cardiac denervation through cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove can reduce the incidence of POAF after CABG. If this procedure is revealed to be effective and safe, it may provide a potential therapeutic approach to prevent POAF in this group of patients., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15–50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when ≥148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset.

Chronic thromboembolic pulmonary hypertension (CTEPH) presents as a progressive vascular condition arising from previous episodes of acute pulmonary embolism, contributing to the development of pulmonary hypertension (PH). Pulmonary thromboendarterectomy (PTE) is the gold-standard surgical treatment for CTEPH; however, it may be associated with postoperative sequelae, including atrial arrhythmias (AAs). This comprehensive literature review explores the potential mechanisms for PTE-induced AAs with emphasis on the role of PH-related atrial remodelling and the predisposing factors. The identified preoperative predictors for AAs include advanced age, male gender, elevated resting heart rate, previous AAs, and baseline elevated right atrial pressure. Furthermore, we explore the available data on the association between post-PTE pericardial effusions and the development of AAs. Lastly, we briefly discuss the emerging role of radiomic analysis of epicardial adipose tissue as an imaging biomarker for predicting AAs.

Background: Postoperative atrial fibrillation (POAF) is a frequent complication of heart surgery, prolonging hospital stays, as well as increasing morbidity and mortality rates. While previous studies have investigated the determinants influencing atrial fibrillation (AF) following heart surgery, the specific risk factors contributing to POAF occurrence after coronary artery bypass graft surgery (CABG) are not well understood. Here we used the human magnetic Luminex assay to assess whether biomarkers, particularly cytokines, within intraoperative pericardial fluid could serve as predictive markers for POAF onset among CABG individuals., Methods: In this study we identified 180 patients who underwent CABG with no atrial arrhythmia history. The human magnetic Luminex assay was used to quantify the levels of 36 cytokines in pericardial fluid samples collected during the surgery. The occurrence of POAF was continuously monitored, using both postoperative electrocardiograms and telemetry strips, until the time of discharge., Results: In our cohort of 124 patients, POAF was observed in 30 patients, accounting for 24.19% of the study population. These patients exhibited significantly higher levels of interleukin (IL)-12p70 in their intraoperative pericardial fluids compared to those with normal sinus rhythms (SR, p < 0.001). Subsequently, IL-12p70 was found to be an independent risk factor for POAF, and receiver operating characteristic (ROC) analysis established a cut-off threshold for predicting POAF onset of 116.435 pg/mL, based on the maximum Youden index (area under the curve: 0.816)., Conclusions: this study establishes a significant association between elevated IL-12p70 levels in intraoperative pericardial fluid and the risk of POAF, particularly when IL-12p70 concentrations exceed the identified cut-off value of 116.435 pg/mL. These findings suggest that IL-12p70 levels could potentially be utilized as a predictive biomarker for the onset of POAF in patients undergoing CABG. This marker may aid in the early identification and management of patients at heightened risk for this complication., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Background New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery. POAF increases the risk of thromboembolism and stroke, as well as morbidity and mortality more generally. Despite evidence from the landmark PROTECT-AF and PREVAIL trials, left atrial appendage ligation (LAAL) is not routinely performed for thromboembolism prophylaxis in POAF, and anticoagulation remains the standard of care along with dual antiplatelet therapy. This study evaluated the efficacy of concomitant LAAL in eliminating the need for postoperative anticoagulation, regardless of POAF development, in patients undergoing coronary artery bypass grafting (CABG). Methods Between 2019 and 2021, 130 patients were selected to undergo concomitant LAAL while undergoing CABG surgery. Patients were then monitored for the incidence of new-onset POAF, and anticoagulation was strictly avoided for this indication. Demographic and outcome data were collected, with endpoints including transient ischemic attack (TIA) or stroke, death, and readmission within one year, as well as the length of hospital and intensive care unit (ICU) admissions. Results POAF occurred in 37 patients (28.5%), consistent with previous reports. However, none of the POAF patients experienced TIA or stroke during the one-year follow-up period, compared to 2 (2.15%) in the non-POAF group, a typical rate of postoperative stroke in such a patient population. No significant differences were observed between POAF and non-POAF cohorts in one-year stroke, all-cause mortality, readmission rates, or total hospital stay. Interestingly, the POAF cohort had a significantly longer mean ICU stay (4.24 vs 3.37 days, p = 0.0219), possibly due to the time required for arrhythmia control before discharge. The study population had a high mean CHA 2 DS 2 -VASc score (2.81), indicating an increased risk of thromboembolism, and a high mean HAS-BLED score, suggesting an elevated bleeding risk with anticoagulation. Conclusions LAAL appears to be an effective adjunct to CABG for thromboembolism prophylaxis in POAF. Formal anticoagulation was avoided in this study, with no significant differences in adverse events between POAF and non-POAF groups, suggesting that LAAL may be a suitable alternative to anticoagulation, especially in high-risk patients (e.g., those with elevated CHA 2 DS 2 -VASc or HAS-BLED scores). The safety and efficacy of this approach should be corroborated by larger randomized studies, such as the ongoing LeAAPS trial. LAAL during CABG may help reduce the risk of bleeding complications associated with anticoagulation while maintaining protection against thromboembolic events in patients who develop POAF., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khalpey et al.)

Objectives: This study aims to investigate the relationship between serum calcium (SC) levels and the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass graft surgery., Methods: This retrospective, observational cohort study consecutively enrolled patients undergoing isolated coronary artery bypass grafting in Beijing Anzhen Hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or atrial flutter or requiring concomitant cardiac surgery were excluded. A logistic regression model was used to determine predictors of POAF. Multivariable adjustment, inverse probability of treatment weighting and propensity score matching were used to adjust for confounders. Moreover, we conducted univariable and multivariable logistic regression analyses on preoperative and postoperative SC and ionized SC levels., Results: The analysis encompassed 12 293 patients. The POAF rate was significantly higher in patients with low SC level than those without (1379 [33.9%] vs 2375 [28.9%], P < 0.001). Low SC level was associated with an increased odds ratio of POAF (odds ratio [95% confidence interval]: 1.27 [1.18-1.37], P < 0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased POAF rate in low SC level group still existed among subgroup analysis based on different age, sex, body mass index, hypertension, hyperlipidaemia, CHA2DS2-VASc and magnesium., Conclusions: Low SC level indicates elevated POAF risk in patients undergoing isolated coronary artery bypass graft surgery even after the adjustment for age, sex, cardiovascular risk factors, echocardiographic parameters and laboratory markers., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Background: Postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality. Epicardial injection of botulinum toxin may suppress POAF., Objectives: This study sought to assess the safety and efficacy of AGN-151607 for the prevention of POAF after cardiac surgery., Methods: This phase 2, randomized, placebo-controlled trial assessed the safety and efficacy of AGN-151607, 125 U and 250 U vs placebo (1:1:1), for the prevention of POAF after cardiac surgery. Randomization was stratified by age (<65, ≥65 years) and type of surgery (nonvalvular/valve surgery). The primary endpoint was the occurrence of continuous AF ≥30 seconds., Results: Among 312 modified intention-to-treat participants (placebo, n = 102; 125 U, n = 104; and 250 U, n = 106), the mean age was 66.9 ± 6.8 years; 17% were female; and 64% had coronary artery bypass graft (CABG) only, 12% had CABG + valve, and 24% had valve surgery. The primary endpoint occurred in 46.1% of the placebo group, 36.5% of the 125-U group (relative risk [RR] vs placebo: 0.80; 95% CI: 0.58-1.10; P = 0.16), and 47.2% of the 250-U group (RR vs placebo: 1.04; 95% CI: 0.79-1.37; P = 0.78). The primary endpoint was reduced in the 125-U group in those ≥65 years of age (RR: 0.64; 95% CI: 0.43-0.94; P = 0.02) with a greater reduction in CABG-only participants ≥65 years of age (RR: 0.49; 95% CI: 0.27-0.87; P = 0.01). Rehospitalization and rates of adverse events were similar across the 3 groups., Conclusions: There were no significant differences in the rate of POAF with either dose compared with placebo; however, there was a lower rate of POAF in participants ≥65 years undergoing CABG only and receiving 125 U of AGN-151607. These hypothesis-generating findings require investigation in a larger, adequately powered randomized clinical trial. (Botulinum Toxin Type A [AGN-151607] for the Prevention of Post-operative Atrial Fibrillation in Adult Participants Undergoing Open-chest Cardiac Surgery [NOVA]; NCT03779841); A Phase 2, Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Dose Ranging Study to Evaluate the Efficacy and Safety of Botulinum Toxin Type A [AGN 151607] Injections into the Epicardial Fat Pads to Prevent Post-Operative Atrial Fibrillation in Patients Undergoing Open-Chest Cardiac Surgery; 2017-004399-68)., Competing Interests: Funding Support and Author Disclosures AbbVie funded this study (NCT03779841) and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. No honoraria or payments were made for authorship. Dr Piccini has received grant support (R01AG074185) from the National Institutes on Aging; has received grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips; and has served as a consultant to Abbott, AbbVie, Bayer, Biotronik, Boston Scientific, Bristol Myers Squibb, Element Science, Itamar Medical, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips, and Up-to-Date. Dr Ahlsson has received grants for clinical research from the Karolinska Institute. Dr Dorian has received grants for research and honoraria from Milestone Pharma; and has received consulting fees from AbbVie. Dr Gillinov has served as a consultant to AtriCure, Medtronic, Edwards Lifesciences, CryoLife, Abbott, and ClearFlow. Dr Kowey has served as a consultant to AbbVie. Dr Mack has served as co-Principal Investigator or Study Chair for trials for Abbott, Edwards Lifesciences, and Medtronic. Dr Noiseux has received consulting fees from AbbVie. Dr Perrault has served as a consultant for ClearFlow, AbbVie Inc, and Maryzime. Dr Steinberg has received grant support (R34HL126921) from the National Heart, Lung, and Blood Institute; has received research support from AliveCor, Medtronic, National Cardiac, and AtriCure; and has served as a consultant to AbbVie, Medtronic, National Cardiac, AtriCure, Hill-Rom, Cardiolectra, and Corfigo. Dr Voisine has served as a consultant for HLS Therapeutics. Dr Waldron has served as a consultant for AbbVie. Drs Gleason, Titanji, and Leaback, Ms O’Sullivan, and Dr Ferguson are employees of AbbVie and may hold stock options. Dr Benussi has received consulting and/or lecturing fees from AtriCure, CryoLife, and Allergan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with late atrial fibrillation (AF) recurrences (late-POAF) and increased morbidity and long-term mortality., Objectives: This study sought to determine device-detected POAF incidence and to identify clinical variables associated with POAF, both in patients with and without preoperative AF history., Methods: A total of 133 consecutive patients undergoing cardiac surgery were prospectively enrolled and continuously monitored with an implantable loop recorder for 2.5 years after surgery. Preoperative transthoracic echocardiography, 12-lead electrocardiogram, blood biomarkers, and clinical data were analyzed to develop prediction models for early- and late-POAF., Results: In patients without preoperative AF history, early-POAF within the first 90 postoperative days occurred in 41 (47.1%) of 87 patients. Late-POAF after the first 90 postoperative days occurred in 22 (25%) of 87 patients, and 20 of these patients also had early-POAF during the first 90 days (20 of 22 [91%]). Increased right atrial minimum volume indexed for body surface area (RAVI min ) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVI min >11 mL/m 2 , age >65 years, and early-POAF, achieved an area under the curve of 0.82 (95% CI: 0.72-0.92). For patients with preoperative AF-history, late-POAF recurrences were frequent (22 of 33 [67%]). Increased RAVI min was independently associated with a higher incidence of late-POAF., Conclusions: In patients with and without AF history, late-POAF recurrences are frequent, including in patients undergoing surgical AF ablation. In patients with no history of AF, late-POAF might be predicted with excellent accuracy by using a combination of preoperative variables. In patients with a history of AF, signs of advanced AF substrate (eg, increased right atrial volumes) were associated with long-term AF recurrences. [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF; NCT03124576]., Competing Interests: Funding Support and Author Disclosures This work was supported by the Netherlands Heart Foundation (CVON2014-09, RACE V [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF]; and grant number 01-002-2022-0118, EmbRACE [Electro-Molecular Basis and the Therapeutic management of Atrial Cardiomyopathy, Fibrillation and Associated Outcomes]), the European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; CATCH ME [Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly], grant number 633196; and MAESTRIA [Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation], grant number 965286). Dr Schotten has received consultancy fees or honoraria from Università della Svizzera Italiana, Roche Diagnostics, EP Solutions Inc, Johnson & Johnson Medical Limited, and Bayer Healthcare; and is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Post-operative new-onset atrial fibrillation (POAF) occurs in approximately 10-40% of patients after coronary artery bypass surgery (CABG). Guidelines for managing atrial fibrillation suggest anticoagulation based on CHA2DS2-VASc risk factors, regardless of arrhythmia. We aimed in this study; to evaluate the factors affecting PAF between patients with persistent AF (PAF) and patients without (non-PAF) and the rates of minor and major bleeding and thromboembolism that may occur under apixaban treatment in our patients who developed POAF after CABG and were treated with apixaban as an anticoagulation drug for one year. Methods: Among 642 patients who underwent elective isolated CABG in our hospital between January 2019 and June 2022, 73 patients with POAF after discharge were included in our study. Demographic characteristics, medical history, perioperative variables and medical data of the patients were analyzed retrospectively from the hospital database. Results: PAF was present after one year in 14 (19.18%) of 73 patients (p<0.001). In PAF patients, age 72.14±5.71 (p=0.002), female gender 11 (78.57%) (p<0.001), body surface area 1.79 (1.57-2.32) (p=0.043)), preoperative CVO of 6 (42.86%) (p<0.001), left atrium diameter mean 5.45 cm (5-6.1) (p<0.001), CHA2DS2-VASc score of 4 and above (p<0.001) 0.001) was found to be significant. In the one year using Apixaban, Epistaxis 4 (28.57%) (p= 0.039) was found to be significant in the PAF group. Between the two groups of PAF and non-PAF, there was no significant difference in terms of GIS bleeding, pericardial hematoma, thoracentesis, reoperation, transfusion, intracranial haemorrhage, thromboembolism, SVO, subcutaneous hematoma. Discussion: The prevalence of POAF varies according to the type and technique of surgery, patient characteristics, arrhythmia method, and arrhythmia definition. It is very important to reveal the risk factors of POAF as it prolongs the hospital stay and increases mortality risk. Although POAF is common after CABG, patient data on anticoagulation and treatment strategies in patients returning to sinus rhythm after discharge are insufficient. According to the guidelines, anticoagulation therapy with rate and rhythm controls is recommended in patients with prolonged POAF (>48 hours) with risk factors or other AF comorbidities. Conclusions: It shows that treatment with apixaban as anticoagulation in patients who develop POAF after isolated CABG can be a safe and effective anticoagulant option with minimal bleeding and thrombotic event risk within one year. More comprehensive multicenter randomized studies are needed to identify POAF risk factors in more detail. [ABSTRACT FROM AUTHOR]

Objective: The amount of epicardial adipose tissue (EAT) is associated with atrial fibrillation (AF). In the study, we measured epicardial adipose tissue thickness (EATT) and some hormone levels in the preoperative period in patients planned for coronary artery bypass grafting (CABG) surgery. We aimed to examine the relationship between these values and postoperative complications, especially postoperative atrial fibrillation (POAF). Methods: Between September 2020 and July 2021, 161 patients were included in the study. The patients' data were collected prospectively from their files. EATT was measured by echocardiogram (ECHO) and computed tomography (CT) and adiponectin, leptin, and resistin hormone levels were measured in the preoperative period for patients undergoing CABG operation. The study evaluated the relationship between those levels and some postoperative complications in patients. Results: A total of 161 patients, 130 male (80.7%) and 31 female (19.3%), were included in the study. The mean age was 61±9 years, body mass index (BMI) was 28.72±5.22 kg/m², and the waist circumference was 100.5±11.1 cm. POAF developed in 29 of the patients (18.0%). There was a statistically significant difference in terms of EATT and left ventricle end-diastolic diameter between the group with POAF and the groups without POAF (EATT in the group with POAF: 6.4±1.9 mm, EATT in the group without POAF: 5.5±1.8 mm) (p<0.05). In multivariate logistic regression analysis, epicardial adipose tissue thickness was shown to be an independent predictor factor in the development of POAF (OR: 1.24, CI: 1.01-1.53, p=0.04). A statistically significant difference was found between EATT and BMI and waist circumference (p=0.002 and p<0.001, respectively). Conclusions: Measuring EATT preoperatively can provide an idea about the development of POAF. A high correlation was found between EATT values measured by CT and ECHO. In this regard, ECHO can be considered a good alternative to CT, which is the gold standard in EATT measurement. ECHO is more accessible, reproducible, and cost-effective without radiation exposure. [ABSTRACT FROM AUTHOR]

Background: Heart surgery patients who develop acute and new-onset AF (postoperative atrial fibrillation, POAF) are among the most common postoperative complications, affecting around 35 percent of those who undergo the procedure. Objective: To assess the effectiveness of amiodarone in prophylaxis of AF post coronary artery bypass surgery (CABG). Patients and Methods: Our work represents a randomized clinical trial, which was carried out at National Heart Institute and Zagazig University from the period of August 2020 to June 2021. 68 patients, admitted for CABG and had high risk score according to POAF score, were included in our study. Results: Regarding mean left ventricular ejection fraction (LVEF), in group I was 47.52±5.85 while in group II it was 49.85±6.25. There was a statistically non-significant difference between the groups with a P value of 0.414. Mean Intensive Care Unit (ICU) period was 4.42±1.35 in group I, and group II was 2.73±0.95. The difference between the groups was statistically significantly shorter among group II (prophylaxis group) (P <0.01). Regarding development of POAF, in group I, the incidence of POAF was 85.3% while in group II, it was 38.2%. Difference among the two studied groups was statistically significantly lower in the group II (prophylaxis group). Conclusion: A prophylactic amiodarone strategy dramatically decreased incidence of POAF risk. All previous estimations of POAF risk reduction using prophylactic amiodarone were found to be accurate. Amiodarone was more effective in preventing postoperative atrial fibrillation with no serious side effects and it decreased postoperative ICU stay. [ABSTRACT FROM AUTHOR]

Objective: Inflammation plays an important role in the initiation of postoperative atrial fibrillation (PoAF) in individuals undergoing cardiac surgery, Thus, this study aimed to investigate the predictive value of the systemic immune inflammation index (SII) to develop PoAF in such patients. Methods: In total, 391 consecutive patients undergoing an isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. PoAF was defined according to the current guideline. The SII is determined using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). Results: The incidence of PoAF in the present study was 24% (n=97 cases). Multivariate logistic regression analysis revealed that the SII was an independent predictor of PoAF (Odds ratio: 1.002 95% confidence interval: (1.001-1.002), p<0.01). The optimal value of the SII in detecting PoAF was established by a receiver operating characteristic curve assessment, and it was >807.8 with 60.8% sensitivity and 80.9% specificity [area under the curve (AUC): 0.7107]. The AUC value of SII in detecting PoAF was much greater than the AUC values of both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (AUC: 0.6740 and AUC: 0.6426, respectively). Conclusions: This study revealed that SII was an independent predictor of PoAF in patients who were operated on for isolated CABG. Additionally, SII had a better discriminative ability for PoAF compared to either NLR or PLR among these cases. [ABSTRACT FROM AUTHOR]

Introduction: Due to its deleterious effects, early identification of patients at risk of postoperative AF (POAF) is of critical importance. Preexisting proarrhythmic atrial remodeling could contribute to this increased risk. Therefore, we aimed to evaluate the presence of preexisting proarrhythmic atrial remodeling and its impact on POAF occurrence in patients undergoing coronary artery bypass grafting (CABG). Methods: Data regarding atrial structural (atrial size and histology), electrical (P-wave and atrial action potential parameters, mRNA expression of several AF-related genes), and autonomic (heart rate variability parameters) proarrhythmic remodeling were compared between patients with (AF; n=11) and without (no-AF; n=19) POAF. Impact of POAF on postoperative outcomes was also evaluated. Results: No significant difference was observed in atrial electrical parameters between the two groups (all p>0.05). However, compared with no-AF, AF patients had more important subepicardial adipose infiltration (p=0.02) and higher markers of parasympathetic and sympathetic modulation (both p=0.03). Patients with POAF had longer hospital stay and more often presented postoperative renal dysfunction (both p=0.04). Conclusion: These findings suggest that preexisting atrial structural (i.e., increased atrial subepicardial adiposity) and autonomic (i.e., sympatho-vagal coactivation) alterations could favor the occurrence of POAF. At its turn, POAF was associated with altered postoperative outcomes in CABG patients. [ABSTRACT FROM AUTHOR]

The present study aims to investigate whether preoperative statin use is associated with less postoperative atrial fibrillation occurrence after septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). Clinical data of consecutive patients with HOCM who underwent septal myectomy between February 2009 and May 2019 at our institution was retrospectively reviewed. The cohort was divided into 2 groups according to the status of preoperative statin use (statin group vs no statin group). Logistic regression was used to explore associations of clinical variables with postoperative atrial fibrillation occurrence. A total of 1307 patients with HOCM underdoing septal myectomy were included in the present study, with 109 patients in the statin group and 1198 in the no statin group. Among 322 patients (24.6%) developing postoperative atrial fibrillation, 21 cases (19.3%) occurred in the statin group, while 301 cases (25.1%) were in the no statin group (P = 0.202). After propensity score matching with confounding variables at baseline, 91 paired patients were included in the matched cohort. Postoperative atrial fibrillation developed in 17 (18.7%) and 38 (41.8%) in the statin and no statin groups, respectively (P = 0.001). Preoperative statin use was associated with less postoperative atrial fibrillation occurrence (odds ratio 0.220, 95% confidence interval 0.083-0.588, P<0.003). The present study suggested that preoperative statin use was associated with less postoperative atrial fibrillation occurrence after septal myectomy in patients with HOCM. This finding may provide clues for subsequent prospective study to investigate this clinical issue. [ABSTRACT FROM AUTHOR]

Background and aim: the aim of current Systematic review and meta-analysis study was evaluate the clinical outcomes of postoperative atrial fibrillation in patients with cardiac surgery. Methods: From the electronic databases, PubMed, Scopus, Web of Science, EBSCO and Embase have been used to perform a systematic literature over the last ten years between 2011and September 2021. Odds ratio with 95% confidence interval (CI), fixed effect model and Mantel-Haenszel method were calculated. The Meta analysis have been evaluated with the statistical software Stata/MP v.16 (The fastest version of Stata). Results: 2153 studies were selected to review the abstracts, the full text of 124 studies was reviewed. Finally, thirteen studies were selected. One-year, five years and ten years mortality in patients with postoperative atrial fibrillation was 14.09%, 8.43% and 17.65%; Odds ratio of overall mortality and Overall stroke was (OR, 0.76 95 % CI 0.67, 0.05; p=0.00) and (OR, 1.40 95 % CI 0.26, 2.53; p=0.02), respectively. Conclusions: In patients with cardiac surgery that after surgery develop POAF, in the first year, the risk of death and stroke is much higher than patients without POAF. As a result, POAF is a significant change in the outcome of heart surgery. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is associated with adverse events after cardiac surgery. Multiple studies have reported that posterior pericardiotomy (PP) may be effective for preventing AF after coronary artery bypass grafting (CABG), but some conflicting results have been reported and the quality of evidence from previous meta-analyses has been limited. The present study aimed to systematically evaluate the safety and efficacy of PP for preventing AF after CABG in adults.Methods: We conducted a quantitative meta-analysis of randomized controlled trials (RCTs) published before May 31, 2021. The primary outcome was AF after CABG under cardiopulmonary bypass. Secondary outcomes included early pericardial effusion, late pericardial effusion, pericardial tamponade, pleural effusion, length of hospital stay, length of intensive care unit (ICU) stay, pulmonary complications, intra-aortic balloon pump use, revision surgery for bleeding, and mortality.Results: Ten RCTs with 1829 patients (910 in the PP group and 919 in the control group) were included in the current meta-analysis. The incidence of AF was 10.3% (94/910) in the PP group and 25.7% (236/919) in the control group. A random-effects model indicated that incidence of AF after CABG significantly lower in the PP group than in the control group (risk ratio = 0.45, 95% confidence interval 0.29-0.64, P < 0.0001). PP also effectively reduced the post-CABG occurrence of early pericardial effusion (RR = 0.28, 95% CI 0.15-0.50; P < 0.05), late pericardial effusion (RR = 0.06, 95% CI 0.02-0.16; P < 0.05), and pericardial tamponade (RR = 0.08, 95% CI 0.02-0.33; P < 0.05) as well as the length of ICU stay (weighted mean difference [WMD] = 0.91,95% CI 0.57-1.24; P < 0.05), while increasing the occurrence pleural effusion (RR = 1.51, 95% CI 1.19-1.92; P < 0.05). No significant differences length of hospital stay (WMD =  - 0.45, 95% CI - 2.44 to 1.54, P = 0.66), pulmonary complications (RR = 0.99, 95% CI 0.71-1.39, P = 0.97), revision surgery for bleeding (RR = 0.84, 95% CI 0.43-1.63, P = 0.60), use of IABP (RR = 1, 95% CI 0.61-1.65, P = 1.0), or death (RR = 0.45, 95% CI 0.07-3.03, P = 0.41) were observed between the PP and control groups.Conclusions: PP may be a safe, effective, and economical method for preventing AF after CABG in adult patients. [ABSTRACT FROM AUTHOR]

Aim. To develop an algorithm for selecting predictors and prognosis of atrial fibrillation (AF) in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG).Material and methods. This retrospective study included 886 case histories of patients with CAD aged 35 to 81 years (median age, 63 years; 95% confidence interval [63; 64]), who underwent isolated CABG under cardiopulmonary bypass. Eighty-five patients with prior AF were excluded from the study. Two groups of persons were identified, the first of which consisted of 153 (19,1%) patients with newly recorded AF episodes, the second — 648 (80,9%) patients without cardiac arrhythmias. Preoperative clinical and functional status was assessed using 100 factors. Chi-squared, Fisher, and Mann-Whitney tests, as well as univariate logistic regression (LR) were used for data processing and analysis. Multivariate LR and artificial neural networks (ANN) were used to develop predictive models. The boundaries of significant ranges of potential predictors were determined by stepwise assessment of the odds ratio and p-value. The model accuracy was assessed using 4 metrics: area under the ROC-curve (AUC), sensitivity, specificity, and accuracy.Results. A comprehensive analysis of preoperative status of patients made it possible to identify 11 factors with the highest predictive potential, linearly and nonlinearly associated with postoperative AF (PAF). These included age (55-74 years for men and 60-78 years for women), anteroposterior and superior-inferior left atrial dimensions, transverse and longitudinal right atrial dimensions, tricuspid valve regurgitation, left ventricular end systolic dimension >49 mm, RR length of 1000-1100 ms, PQ length of 170-210 ms, QRS length of 50-80 ms, QT >420 ms for men and >440 ms for women, and heart failure with ejection fraction of 4560%. The metrics of the best predictive ANN model were as follows: AUC — 0,75, specificity — 0,73, sensitivity — 0,74, and accuracy — 0,73. These values in best model based on multivariate LR were lower (0,75; 0,7; 0,68 and 0,7, respectively).Conclusion. The developed algorithm for selecting predictors made it possible to verify significant predictive ranges and weight coefficients characterizing their influence on PAF development. The predictive model based on ANN has a higher accuracy than multivariate HR.

Background. In patients who underwent cardiac surgery, first-time postoperative atrial fibrillation (POAF) is associated with increased incidence of hospital-acquired complications and mortality. Systemic inflammation is one of confirmed triggers of its development. The anti-inflammatory properties of colchicine can be effective for the POAF prevention. However, the results of several studies were questionable and required further investigation. Hence, we aimed to evaluate the effectiveness of low-dose short-term colchicine administration for POAF prevention in patients after the open-heart surgery. This double-blind randomized placebo-controlled trial included 267 patients, but 27 of them dropped out in the course of the study. Study subjects received the test drug on the day before the surgery and on postoperative days 2, 3, 4 and 5. The rhythm control was conducted immediately after the operation and until the discharge from the hospital. The final analysis included 240 study subjects: 113 in the colchicine group and 127 in the placebo group. POAF was observed in 21 (18.6%) patients of the colchicine group vs. 39 (30.7%) control patients (OR 0.515; 95% Cl 0.281–0.943; p = 0.029). We observed no statistically significant differences between the patient groups in the secondary endpoints of the study (hospital mortality, respiratory failure, stroke, bleeding, etc.). For other parameters characterizing the severity of inflammation (pericardial effusion, pleural effusion, WBC count, neutrophil count), there were statistically significant differences between the groups in the early postoperative period (days 3 and 5). Also, statistically significant differences between the groups in the frequency of adverse events were revealed: the incidence of diarrhea in the colchicine group was 25.7% vs. 11.8% in the placebo group (OR 2.578; 95% Cl 1.300–5.111; p = 0.005); for abdominal pain, incidence values were 7% vs. 1.6%, correspondingly (OR 4.762; 95% Cl 1.010–22.91; p = 0.028). Thus, there were statistically significant differences between groups in the primary endpoint, thereby confirming the effectiveness of short-term colchicine use for the POAF prevention after coronary artery bypass grafting and/or aortic valve replacement. Also, we detected statistically significant differences between groups in the frequency of side effects to colchicine: diarrhea and abdominal pain were more common in the colchicine group. This clinical trial is registered with ClinicalTrials database under a unique identifier: NCT04224545.

The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.

Background: Atrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20–edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence. Results: Patients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627–0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207–12.186), and age (OR 1.181, 95% CI 1.011–1.379). Conclusion: Preoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) after esophagectomy for esophageal cancer is not uncommon. The aim of this study is to examine whether preoperative transthoracic echocardiography is useful for predicting new-onset POAF in esophageal cancer. Methods: In this prospective observational study, we evaluated 200 patients with esophageal cancer who underwent esophagectomy at our hospital between January 2016 and July 2019. Conventional echocardiographic assessment and tissue Doppler imaging were performed before surgery. We investigated the utility of preoperative transthoracic echocardiography for predicting new-onset POAF in esophageal cancer. Results: New-onset POAF occurred in 51 (25.5%) of 200 patients. POAF was significantly associated with older age (p = 0.007), higher body mass index (p = 0.020), preoperative hypertensive disease (p = 0.021), and lower hemoglobin level (p = 0.028). The incidence of postoperative complications was significantly higher in patients with POAF than in patients without POAF (43.1% vs. 24.2%, p = 0.013). Transthoracic echocardiography showed that left atrial diameter (LAD) and E wave/e′ wave ratio (E/e′) were significantly higher in patients with POAF than in patients without POAF (34.1 vs. 31.3 mm, p < 0.001 and 11.6 vs. 10.5, p = 0.003, respectively). Multivariate analysis showed that LAD ≥ 36.0 mm, E/e′ ≥ 8.4 are independent risk factors for POAF (odds ratios 2.47 and 3.64; p values 0.035 and 0.027, respectively) Conclusions: Preoperative echocardiographic evaluation is useful for predicting the onset of POAF after esophagectomy for esophageal cancer. Risk stratification using LAD and E/e′ enables clinicians to identify patients at high risk for POAF before esophagectomy. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients.Objective: To evaluate the management of POAF in a cardiac surgery department, characterize the extent of its variability, and develop a standardized protocol.Methods: This was an observational retrospective study with data from patients who underwent cardiac surgeries with subsequent POAF between January 1, 2017, and June 1, 2018. We assessed the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy, and both among different hospital units. We also assessed the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation.Results: Data from 97 patients were included in this study. The POAF management strategy differed significantly among the 3 types of hospital units (P = 0.001). Considering all POAF episodes (including all recurrences), 83 of the 97 patients (85.6%) received amiodarone as part of the RhC strategy. Anticoagulation was used in 58 (59.8%) patients and was suboptimal according to the study criteria in 29.5% of the patients included. Based on these results, a hospital working group developed a standardized protocol for POAF management.Conclusions and Relevance: POAF management was heterogeneous at our institution. This article highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices. [ABSTRACT FROM AUTHOR]

Aims  Atrial fibrillation (AF) is a commonly occurring arrhythmia after cardiac surgery (postoperative AF, poAF) and is associated with poorer outcomes. Considering that reduced atrial contractile function is a predictor of poAF and that Ca2+ plays an important role in both excitation–contraction coupling and atrial arrhythmogenesis, this study aims to test whether alterations of intracellular Ca2+ handling contribute to impaired atrial contractility and to the arrhythmogenic substrate predisposing patients to poAF. Methods and results  Right atrial appendages were obtained from patients in sinus rhythm undergoing open-heart surgery. Cardiomyocytes were investigated by simultaneous measurement of [Ca2+]i and action potentials (APs, patch-clamp). Patients were followed-up for 6 days to identify those with and without poAF. Speckle-tracking analysis of preoperative echocardiography revealed reduced left atrial contraction strain in poAF patients. At the time of surgery, cellular Ca2+ transients (CaTs) and the sarcoplasmic reticulum (SR) Ca2+ content were smaller in the poAF group. CaT decay was slower in poAF, but the decay of caffeine-induced Ca2+ transients was unaltered, suggesting preserved sodium-calcium exchanger function. In agreement, western blots revealed reduced SERCA2a expression in poAF patients but unaltered phospholamban expression/phosphorylation. Computational modelling indicated that reduced SERCA activity promotes occurrence of CaT and AP alternans. Indeed, alternans of CaT and AP occurred more often and at lower stimulation frequencies in atrial myocytes from poAF patients. Resting membrane potential and AP duration were comparable between both groups at various pacing frequencies (0.25–8 Hz). Conclusions  Biochemical, functional, and modelling data implicate reduced SERCA-mediated Ca2+ reuptake into the SR as a major contributor to impaired preoperative atrial contractile function and to the pre-existing arrhythmogenic substrate in patients developing poAF. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is a frequent adverse event after thoracic surgery with associated morbidity, mortality, and healthcare costs. It has been shown to be preventable with prophylactic amiodarone, which is only recommended in high-risk individuals due to the potential associated side effects. Risk factors for POAF have been identified and incorporated into a prediction model to identify high-risk patients. Further evaluation in the form of a multicenter clinical trial is required to assess the effectiveness of prophylaxis specifically in this high-risk population. The feasibility of such a trial first needs to be assessed.Methods: The PREP-AF trial is a double-blind randomized controlled feasibility trial. Individuals undergoing major thoracic surgery who are identified to be high-risk by the POAF prediction model will be randomized 1:1 to receive a short course of amiodarone vs. placebo in the immediate postoperative period. The primary outcome is feasibility, which will be measured by the number of eligible patients identified, consented, and randomized; intervention adherence; and measurement of future outcomes of a full trial.Discussion: This study will determine the feasibility of a randomized controlled trial to assess the effectiveness of prophylactic amiodarone, in high-risk patients undergoing major thoracic surgery. This will inform the development of a multi-center trial to establish if prophylactic amiodarone is safe and effective at reducing the incidence of POAF. Preventing this adverse event will not only improve outcomes for patients but also reduce the associated health resource utilization and costs.Trial Registration: ClinicalTrials.gov NCT04392921 . Registered on 19 May 2020. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) after cardiac surgery is a major health problem that is associated with a significant financial burden and increased early morbidity and mortality. We investigated the accuracy of new echocardiographic derived indices to predict patients at higher risk of developing POAF. 84 consecutive patients (age 57.9 ± 6.9, 32% female) hospitalized for isolated CABG underwent comprehensive echocardiographic evaluation before surgery. Left atrial (LA) function was quantified through the assessment of phasic LA volumes to calculate LATEF. Speckle tracking echocardiography STE was used to measure LA reservoir strain, conduit strain and booster strain. Patients who developed POAF had increased LA volumes and impaired LA functions assessed by both the volumetric phasic changes and STE. By univariable analysis, all LA function parameters significantly predicted POAF. Multivariate regression analysis showed that age (P = 0.03, OR 1.134, 95% CI 1.012–1.271) and LATEF (P = 0.001, OR 0.814, 95% CI 0.725–0.914) were strong independent factors for POAF with LATEF showing the highest predictive accuracy. After multivariable adjustment to include LA strain indices to the base model, LA contractile strain LACtS (23.93 ± 4.19 vs 37.0 ± 3.35, p < 0.001) was the best discriminated for the highest predictive accuracy (OR 0.429, 95% CI 0.26–0.708). The ROC Curve was calculated for the greatest performance for prediction of POAF (AUC LACtS: 0.992; LATEF: 0.899). Adding new left atrial mechanics parameters is a more sensitive, independent tool that provides an incremental predictive value to discriminate patients at more risk for POAF. [ABSTRACT FROM AUTHOR]

Background: The development of atrial fibrillation (AF) is a complex multifactorial process. Over the past few decades, much has been learned about the pathophysiological processes that can lead to AF from a variety of specific disease models in animals. However, our ability to recognise these disease processes in AF patients is still limited, which has contributed to the limited progress in improving rhythm control in AF. Aims/objectives: We believe that a better understanding and detection of the individual pathophysiological mechanisms underlying AF is a prerequisite for developing patient-tailored therapies. The RACE V Tissue Bank Project will contribute to the unravelling of the main molecular mechanisms of AF by studying histology and genome-wide RNA expression profiles and combining this information with detailed phenotyping of patients undergoing cardiac surgery. Methods: As more and more evidence suggests that AF may occur not only during the first days but also during the months and years after surgery, we will systematically study the incidence of AF during the first years after cardiac surgery in patients with or without a history of AF. Both the overall AF burden as well as the pattern of AF episodes will be studied. Lastly, we will study the association between the major molecular mechanisms and the clinical presentation of the patients, including the incidence and pattern of AF during the follow-up period. Conclusion: The RACE V Tissue Bank Project combines deep phenotyping of patients undergoing cardiac surgery, including rhythm follow-up, analysis of molecular mechanisms, histological analysis and genome-wide RNA sequencing. This approach will provide detailed insights into the main pathological alterations associated with AF in atrial tissue and thereby contribute to the development of individualised, mechanistically informed patient-tailored treatment for AF. [ABSTRACT FROM AUTHOR]